Food Pharmacy

Onboarding Guide
Developed Fall 2017
Updated 2020
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Introduction
Congratulations on taking the next steps towards starting a Food Pharmacy! This guide gives a
brief overview of the elements that are involved in planning and executing a Food Pharmacy at
primary care clinics. Below is general introductory information.

Food Pharmacies are supported by the Food as Medicine Collaborative, a multi-sector

collaborative in San Francisco which seeks to advance health equity by developing deep,
effective, interwoven partnerships between healthcare and food systems to address food
insecurity and support nutritional health for underserved patient populations. We do this by
developing the systems change, policies, and programs needed for alignment between healthcare
and food systems.

For more information about the Food as Medicine Collaborative and Food Pharmacy, please
contact Erin Franey, erin.franey@sfdph.org.
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What is a Food Pharmacy?

A Food Pharmacy is a comprehensive, clinically-based food program that promotes and enables healthy
eating. Providers in a clinical setting can write prescriptions for healthy foods, and patients can fill these
prescriptions at the Food Pharmacy where they will receive not only healthy foods, but also nutrition
education, cooking demonstrations, basic culinary tools and ingredients to encourage cooking, health
education, chronic disease management counseling, and referrals to food resources to further address
food insecurity. The goal of Food Pharmacy is to increase patient food security and promote and enable
sustained behavior change that will improve patients’ health.

What makes a Food Pharmacy different from a regular food pantry?

In close collaboration with nutritionists, Food Pharmacy ensures food items offered are consistent with
recommended diets for patients with high blood pressure and diabetes. Education and empowerment are
key aspects of Food Pharmacy; in addition to cooking demonstrations and nutrition education, we provide
recipe cards and cookbooks, basic culinary tools and ingredients like spices and olive oil, and referrals to
food resources. Onsite clinicians such as a pharmacist, nurse, or doctor check patients’ blood pressure
and/or blood glucose, and provide one-on-one counseling for patients.Additionally, patients are
encouraged to take leadership roles in the program by volunteering and serving as patient advisors.

What does it cost?

Through the tremendous work of the San Francisco Marin Food Bank (SFMFB) and a growing number of
partnerships with the non-profit and business sectors, all food items are provided in-kind. Food
Pharmacies are traditionally run by a mix of clinic staff and volunteers, requiring no additional funding for
staff time. The Food as Medicine Collaborative continuously seeks opportunities to support Food
Pharmacies by recruiting volunteers and interns, securing additional funding, and cultivating partnerships
for donated food items and cooking equipment.

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Who is this guide for?

This guide was created to introduce interested clinics to Food Pharmacy and help with planning. You will
find resources, common practices, answers to frequently asked questions, and more in this guide. This
guide should be used in tandem with the resources in the shared Google drive and in collaboration with
staff at the Food as Medicine Collaborative at the San Francisco Department of Public Health. Note that
each clinic has a different culture and ways of organizing so take these suggestions, templates, and
timelines with your specific clinic in mind. Patient populations vary as well so aim to tailor Food Pharmacy
to your patients’ needs and preferences. ​Extensive support from the Food as Medicine Collaborative is
available to clinics located within San Francisco, but all clinics can learn planning strategies and best
practices from this guide.

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New Pharmacy Onboarding Timeline

Planning for a Food Pharmacy in your clinic takes time and preparation. Below is an outline of the
steps and meetings that should occur in advance of the launch date. The ​Clinic Liaison​ is your
clinic's designated staff member leading the program who will work closely with Food as Medicine
Collaborative staff to ensure all specific preparation steps are executed.
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2-3 months ahead

● Secure approval from Clinic Leadership
● Initial meeting with Food as Medicine Collaborative and Food Bank
○ Learn about Food Pharmacy program and each organization
○ Clinic tour and vision for program
○ Walk through Logistics Planning Worksheet (see Logistics Planning guiding
questions below)
○ Share time expectations
○ Identify Clinic Liaison
○ Discuss potential timing of Food Pharmacy and coordinate delivery schedule with
Food Bank

1-2 months ahead

● Follow-up meeting with Food as Medicine Collaborative and Food Bank
○ Review Logistics Planning Worksheet
○ Food Bank application submission and approval; menu exclusions
○ Plan for launch day
○ Share available resources: cooking and nutrition education curricula, bin signs,
recipe cards, cookbooks, etc.
○ Discuss materials/supplies needs and raffle
● Staff and Volunteer Recruitment
○ Trainings
○ Solidifying stations
● Patient Recruitment
○ Referrals
○ Outreach calls
○ Mailers

1-2 weeks ahead

● Weekly Check-Ins with Food as Medicine Collaborative and Food Bank staff
● Patient Recruitment
○ Follow-up and reminder calls
● Dry Run with Food Bank
● Materials Preparation

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Launch Day!
12 week pilot period
● Continued weekly Check-Ins with Food as Medicine Collaborative and Food Bank staff
● Continued Patient Recruitment
● Sustainability/Extension Discussion

Logistical Planning
Many logistics need to be discussed and decided before planning for the launch can begin. The
Food Pharmacy Planning Worksheet is located ​here​. It is introduced at the initial meeting with the
Food as Medicine Collaborative and Food Bank, and filled in collaboratively by the second
meeting. Below is a summary and preview of the questions and things to consider.
____________________________________________________________________________________________________________________________________________

● What day and what time?

● Where in the clinic?
● How often (twice a week, weekly, every other week, etc)?
● How long will patients be part of the program?
● If applicable, what does graduation look like?
● What stations do you plan to include?
● What is your leftover plan?

● Who is your target population?

● How will you ensure the prioritized patients get
referred?
● Who will refer patients to Food Pharmacy?
● How will patients be referred to the program?
● What materials, if any, will be given to patients when they are
referred?
● How many patients do you hope to serve weekly?

● Who will serve as the Clinic Liaison (role description below)?

● Which clinicians are available to staff Food Pharmacy?
● Who else is available to staff Food Pharmacy?
● How will providers and other staff know Food Pharmacy is
available to patients?
● What overlap/coordination/communication can there be with
RN Chronic Care Visits or other relevant programs (if applicable)?

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● What is the current role of the Patient Advisory Board (if

applicable)? Who coordinates your PAC? When are PAC meetings?
Would they be interested in getting involved in something like this?
● Are there any existing volunteers, such as scribes, that would be
interested?
● Are there local churches, community groups, youth groups, etc
where you could recruit volunteers?

● How will your clinic track attendance? Who will track it?
● How will you ensure pre and post surveys are administered?
● Will you register patients in your EHR? Will you bill for visits?

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Your Role: Clinic Liaison

As the Clinic Liaison, you serve as the point person between the clinic, Food as Medicine
Collaborative, Food Bank, and other Food Pharmacy partners. Below are the time expectations
for each of your responsibilities. Clinic liaisons also have access to a Food Pharmacy shared
google drive folder, which contains many support resources and templates that are later
discussed in this guide.
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Launch Preparation

Task Category Task Responsibilities Time Estimate Reason

Working with the ● Food Handler → 2 hour ● Ensures food safety protocols
Food Bank Training are practiced at food pharmacy
● Clinic tour; Pantry → 1 hour ● Coordinate drop off and
agreement and transport for produce
application

Logistical Planning
● Logistics Worksheet
● Food Pharmacy Map
● Station Finalization
→ 1 hour ● Outlines major details that need
to be in place before start of
Food Pharmacy
→ 0.5 hour ● Map visualizes flow of food
pharmacy session
→ 1 hour ● Finalizing available stations so
materials can be secured (BP
cuffs, resource binder, etc)

Meetings & Check-Ins ● Clinic leadership → 1 hour/each ● Ensures that clinic has capacity
(as needed) meeting and resources for food rx
● Check-ins with → 30 min/each ● Checks on logistics, details, any
Central Coordinator troubleshooting

Patient recruitment ● Creating worklists for → 1 hour ● Working with database to pull
outreach patients that fit the target
population
● Outreach calls → 2-4 ● Calling patients to inform about
hours/week new program and doing
reminder calls
● Notifying staff for ● Sharing details of Food
referrals → 1 hour/week Pharmacy with staff so patients
can be referred

TOTAL 15-20 hours over a 2 month period

*On your launch date, the clinic should have the following materials:
● 4-6 tables ● Sign-In Sheet ● Pens and
● Extra baskets or ● BP cuff clipboards
large bowls ● Chairs ● Kitchen basics for
(optional) cooking demos

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*On your launch date, you will receive the following materials from the Food Bank:
● Metal buckets ● Scoops ● Volunteer pins
● Checkered tablecloths ● Gloves

*On your launch date, you will receive the following materials from the Food as Medicine
Collaborative:
● Recipe books ● Laminated volunteer ● Laminated bin signs
● Recipe cards cards ● Pre and post surveys
● Banner with slogan ● Food tips ● Sample cups, and
● Laminated station signs ● Resource binder utensils, and napkins
● Grocery bags

Weekly Preparation​ ​(more detailed version h

​ ere)​

Task Category Task Responsibilities Time Estimate Reason

Preparation (1-4 days ● Weekly Check-In Call → 0.5 hour ● Debrief the previous session and
before session) ● Attendance and outlining improvement ideas
Survey Tracking ● Update tracking and survey
→ 1 hour spreadsheets with patients
● Outreach and attended previous week
Reminder Calls → 2-4 hours ● Remind patients and gathering
● Clinic feedback from previous session
Communication ● Remind staff to refer patients;
→ 0.5 hour follow-up with any new referrals
● Materials Preparation
● Print any needed materials
→ 0.5 hour (sign-in sheet, fliers, etc.)

Set-Up (~1 hour ● Overall Set-Up → 0.5 ● Organize space for session
before session) Organization (moving tables, tablecloths, etc.)
● Food Set-Up → 0.5 ● Organize food in aesthetic manner
● Check in with volunteers on
● Pre-Huddle → 0.1 hour responsibilities and theme of the
day
● Cooking demo prep → 0.5 hour ● Pick recipe, select and prep
ingredients

Clean-Up (1 hour after ● Leftovers → 0.5 hour ● Give leftovers to patients in

session) waiting room or nearby community
resource
● Loose ends → 0.1 hour ● Collect intake forms, referrals from
clinic staff, etc.
● Basic Clean → 0.25 hour ● Clean buckets and composting
any spoiled produce
● Post-Huddle → 0.1 hour ● Review positives of the day and
areas of improvement

TOTAL ~6 hours per week (+1-2 hours for Food Pharmacy session time)

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Staff & Volunteers

Food Pharmacy cannot run without the help of staff and volunteers. To assist with capacity
planning, the following tables outline how many individuals (including you) are needed for a
successful session. Remember that you will need help with set-up and clean-up in addition to
staffing the program. Plan for 3-4 staff and/or volunteers to spend 30 minutes to an hour before
AND after Food Pharmacy for set-up and clearn-up.
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To fulfill the Food Pharmacy goals of encouraging sustained behavior changes and improving
health outcomes, the following stations are recommended at each Food Pharmacy session. They
are categorized based on necessity to help Clinic Liaisons identify and assign volunteers if you
happen to be short staffed during certain weeks. However, when planning for your launch and
pilot period, ​do not staff​ for only essential stations. Try and secure as many staff or volunteer
members as possible (6-7 individuals maximum at one session).

Food Pharmacy Stations

Stations # of Staff/
Duties
(Suggested Staff) Volunteers

Essential Stations

Sign-In (Intake) ● Welcome patients - check in, orient patients to

stations, distribute recipe books 1
● Administer pre- or post- surveys

Food Distribution ● Assist with food selection & check baskets for
spoiled produce
1-2
● Engage with patients - ask about favorite produce,
recipes, etc., share recipe cards and food tips

Additional Ideal Stations

Food Demonstration ● Prepare food demo - share takeaways of lesson plan

1
(i.e. Registered Dietitian) ● Serve as a resource - answer any nutrition questions

Referral Table ● Guide patients through neighborhood resources

(i.e. BA or MEA) and assess other food-related needs (e.g. CalFresh, 1
EatSF, Project Open Hand, etc.)

Blood Pressure ● Blood Pressure monitoring - take BP and/or BG for

Education patients and explain the numbers
(i.e. RN, PharmD, MD) ● Health coaching - brainstorm with patients 1
strategies for managing their chronic disease
● Clinical visit - lifestyle and medication management

Nutrition Education ● Interactive activities/handouts designed to help

(i.e. Intern or volunteer) empower patients to make informed nutrition and 1
health related choices

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Resources
You are not alone! We have created many documents, templates, forms, and more to assist you
with your planning and preparation for Food Pharmacy. Outlined below are the core documents
​ rin.franey@sfdph.org.​
needed for your launch day. Contact Erin Franey to request documents - e
____________________________________________________________________________________________________________________________________________

1. Onboarding Guide​ - ​you can always refer back to this guide which can be found in this folder

2. Launch Standard Work​ - ​the Standard Work table gives more detail into the tasks and
responsibilities to be done before launch day. On this document, both the roles of the central
coordinator and the liaison are outlined with similar time estimations.

3. Weekly Checklist Template​ - ​the Weekly Checklist sheet provides more details for the various
tasks to be completed during the weeks with food pharmacy sessions.

4. Tracker Template​ ​- the Tracker template provides a framework on how to set up your outreach list
so you can effectively record attendance and follow up with patients on referrals.

5. Outreach Call Script​ - ​the Outreach Call Script was developed by members of the HTN workgroup
to create a patient-friendly way to introduce the Food Pharmacy program to new patients over the
phone. Areas highlighted in yellow should be replace with clinic-specific info.

6. Referral Form Template​ - ​the Referral Form template is for clinic providers and staff to record the
information of patients who would be a good fit for the Food Pharmacy. They would hand these
slips to you or placed in a box for you to update your outreach list before the next session.

7. Intake Survey Template​ - ​the Intake Survey is given to patients on their first visit to gather data
about their food access, chronic disease management, fruit and vegetable intake, and more. On
the template, areas highlighted in yellow should be substituted with your clinic name.

8. Mailers​ -​ the Mailers serve two purposes: you can print out the first page for providers and staff to
give to patients during visits. You can also print both sheets double-sided as postcards to mail to
patients on your outreach call list.

9. Volunteer Responsibilities and Agreement -​ ​the Volunteer resources are provided for new
volunteers to learn their roles accompanied by an agreement outlining the goals and values of the
Food Pharmacy.

Using the Core Documents for Launch

● Each clinic has a clinic specific folder in the shared Google Drive
● To edit a core document:
1. Make a copy
2. Change the filename to include “_​ClinicName​” at some place in the title
3. Move the edited document to your clinic specific folder
Additionally, there is a ​Clinic Resources ​folder that has many other documents that are helpful
but are not essential for your launch day.

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Partnerships
Our work is only possible through collaborations with other organizations and programs that
provide nutrition education and community resources to patients. Food as Medicine Collaborative
staff organize each resource centrally to make them available for your respective Food Pharmacy.
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San Francisco Marin Food Bank strives to end hunger in San Francisco
and Marin, envisioning a community where everyone is able to obtain
enough nutritious food to support the health and well-being of themselves
and their families. From the pantry network and home-delivered groceries
to nutrition-education classes and food-stamp enrollment, we work in many
ways to nourish and empower neighbors in need.
Applicable to Food Pharmacy: ​fresh produce, nutrition education, food
handler safety trainings, calfresh assistance, neighborhood food pantries

Leah’s Pantry is a California-based nonprofit committed to a vision of all

people being nourished, regardless of socioeconomic status. Our
programs and products are designed to ensure all people have access to
healthy food and feel competent preparing easy, nutritious meals for
themselves and their families.
Applicable to Food Pharmacy: ​kitchen-in-a-bag kits, EatFresh.org
recipe cards, cookbooks

Vouchers 4 Veggies is a transformative program to increase access and

affordability of healthy foods for low-income individuals and families by
providing free vouchers for fruit and vegetables.
Applicable to Food Pharmacy: ​Voucher enrollment and distribution

Additional Partners:

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Frequently Asked Questions

Below are some frequently asked questions and known challenge spots where we’ve identified
best practices. If you ever have a specific question, feel free to check in with Food as Medicine
Collaborative staff at any time.
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How many patients should be on our outreach call list?

This number depends on your target weekly attendance rate. However, your initial list used for
recruitment before Food Pharmacy begins will be much longer than your weekly outreach and
reminder call list once you have launched your Food Pharmacy. For instance, if your goal is to
serve 40 patients per week, your initial outreach list could have around 200 patients. Considering
patients with disconnected phone numbers and voicemails, you may actually speak with 100
patients​.​ Of those patients, 80 are usually interested with 60 saying that they will attend as the time
fits their schedule. Of those 60 patients, half usually come to the session. From this point forward
your outreach list can include those who voiced interest and be increased from clinic staff referrals.

How do I create an outreach list with the target population of patients?

Your clinic analyst can pull worklists from Tableau to get the information for all patients that fit
your specific eligibility criteria. If your clinic does not have an analyst or is not familiar with
Tableau, let Food as Medicine Collaborative staff know.

If I don’t have a Registered Dietitian staffed to do food demonstrations, who can take on
that role and what samples should they make?
Any clinic staff or a volunteer can facilitate cooking demonstrations. However, the individual
must have taken a food handler safety training or be familiar with the guidelines. Additionally, in
the shared Google drive, the Nutrition Education folder has lesson plans and recipes that are
nutritious and healthy and can be used during Food Pharmacy.

If I don’t have a Health Coach or a medical practitioner staffed to take blood pressure, who
can take on that role and what do they need to know?
You or a volunteer is allowed to take blood pressure ​if it is okay with your clinic leadership. ​If
your clinic decides to have a BP monitoring station, you must ensure that there are measures in
place to handle elevated BPs if found during a food pharmacy session. We have an elevated BP
workflow, but you will need to talk with clinic leadership and staff about the specifics.

How do I help new volunteers learn their responsibilities?

Spend a little bit of time with new volunteers to orient them to their role and sign volunteer
agreement forms. Also review their volunteer card with them and make sure that it is taped to their
station so they can refer back to it during the session. Lastly, use the pre-huddle to introduce the
new volunteer to the rest of the group and reinforce responsibilities.

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What do we do with leftovers?

After most sessions, it is normal to have a few leftovers even if the quantity you received in terms
of households matches the number of patients who attended. For instance, you ordered for 45
households, 45 patients arrived, and there are still leftovers. The remaining food can be given to
patients in the waiting room or taken to a nearby shelter or community resource center. However,
no leftovers can be given to non-eligible volunteers or clinic staff. ​If it is taking longer than an
hour to give away leftovers, check in with your Neighborhood Representative at the Food Bank to
modify the quantity you receive for the next session.

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